| Basic metabolic panel | $174 | $8 | 2054% | — | 3 |
| CT abdomen and pelvis with contrast | $125 | $356 | 35% | — | 4 |
| CT head without contrast | $891 | $107 | 834% | — | 4 |
| CT pelvis with contrast | $1,318 | $179 | 736% | — | 4 |
| Colonoscopy with biopsy | $3,264 | $1,223 | 267% | — | 3 |
| Colonoscopy with polyp removal | $3,241 | $1,223 | 265% | — | 3 |
| Colonoscopy, diagnostic | $2,984 | $950 | 314% | — | 3 |
| Complete blood count with differential | $6 | $8 | 81% | — | 4 |
| Complete blood count, automated | $56 | $6 | 862% | — | 3 |
| Comprehensive metabolic panel | $57 | $11 | 543% | — | 4 |
| Diagnostic mammography, both breasts | $69 | — | — | — | 4 |
| Diagnostic mammography, one breast | $195 | — | — | — | 4 |
| ED visit, level 3 | $580 | $279 | 208% | — | 4 |
| ED visit, level 4 | $889 | $426 | 208% | — | 4 |
| ED visit, level 5 | $2,119 | $608 | 348% | — | 4 |
| Electrocardiogram with interpretation | $55 | — | — | — | 3 |
| Excision of breast lesion | $2,654 | $4,000 | 66% | — | 3 |
| Family psychotherapy, with patient | $1,018 | $181 | 562% | — | 2 |
| Family psychotherapy, without patient | $970 | $181 | 535% | — | 2 |
| Group psychotherapy | $992 | $104 | 956% | — | 2 |
| Kidney function panel | $198 | $9 | 2285% | — | 3 |
| Lipid panel | $37 | $13 | 278% | — | 4 |
| Liver function panel | $127 | $8 | 1552% | — | 3 |
| MRI brain with and without contrast | $1,631 | $356 | 458% | — | 4 |
| MRI lower extremity joint (knee) | $1,196 | $244 | 490% | — | 4 |
| MRI lumbar spine without contrast | $1,265 | $244 | 519% | — | 4 |
| OB ultrasound, 14+ weeks | $708 | $107 | 662% | — | 3 |
| Office consultation, comprehensive | $347 | — | — | — | 2 |
| Office consultation, moderate | $315 | — | — | — | 2 |
| Office visit, established patient, level 3 | $327 | — | — | — | 2 |
| Office visit, established patient, level 4 | $355 | — | — | — | 2 |
| Office visit, new patient, level 3 | $355 | — | — | — | 2 |
| Office visit, new patient, level 4 | $412 | — | — | — | 2 |
| Office visit, new patient, level 5 | $453 | — | — | — | 2 |
| PSA (prostate specific antigen), total | $8 | $18 | 42% | — | 3 |
| Partial thromboplastin time | $61 | $6 | 1013% | — | 3 |
| Physical therapy, therapeutic exercise | $96 | — | — | — | 4 |
| Preventive visit, new patient, 18-39 | $366 | — | — | — | 2 |
| Preventive visit, new patient, 40-64 | $386 | — | — | — | 2 |
| Prothrombin time | $58 | $4 | 1344% | — | 3 |
| Psychotherapy, 30 minutes | $347 | $181 | 191% | — | 3 |
| Psychotherapy, 45 minutes | $429 | $181 | 236% | — | 3 |
| Psychotherapy, 60 minutes | $443 | $181 | 244% | — | 3 |
| Screening mammography, bilateral | $51 | — | — | — | 3 |
| Sleep study (polysomnography) | $4,777 | $877 | 545% | — | 3 |
| Thyroid stimulating hormone (TSH) | $15 | $17 | 87% | — | 4 |
| Transforaminal epidural, lumbar/sacral | $473 | $904 | 52% | — | 3 |
| Ultrasound, abdomen, complete | $1,030 | $107 | 964% | — | 3 |
| Ultrasound, transvaginal | $814 | $107 | 762% | — | 3 |
| Upper GI endoscopy, diagnostic | $2,889 | $927 | 312% | — | 3 |
| Urinalysis, automated, with microscopy | $131 | $3 | 4126% | — | 3 |
| Urinalysis, automated, without microscopy | $35 | $2 | 1546% | — | 4 |
| Urinalysis, manual, with microscopy | $33 | $4 | 819% | — | 3 |
| Urinalysis, manual, without microscopy | $9 | $3 | 262% | — | 4 |
| X-ray, lower back, 4+ views | $505 | $107 | 473% | — | 4 |